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 Clinical Departments use the information to identify patients, order clinical services, and retrieve medical records.  The Business Office uses the information to gather charges, create bills, and develop reports about services rendered at the Hospital. First impressions are crucial and the Patient Access staff is often the first staff encountered by patients. Many other departments depend on the information that is entered into the system during the registration process. Patient Access and Revenue Cycle First ImpressionsRelationships

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Insurance Verification  Quality  Productivity  Number of pre-registration accounts at admit and at hours  Number of emergency admits within hours  Number of due diligence complete  Identify field in system reportable – touched, untouched

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Medicare Secondary Payer refers to situations where the Medicare Program does not have primary responsibility for paying a beneficiary’s health care expenses.  CMS has mandated that providers must determine whether Medicare will be the patient’s primary or secondary coverage.  The Medicare beneficiary is required to answer a specific set of questions to determine which insurance coverage is primary.  CMS states that providers should retain MSP questionnaires for 10 years. This is consistent with the length of time the government may conduct investigations related to the False Claims Act. Medicare Secondary Payer (MSP)

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MSP Examples There are seven instances where Medicare may be the secondary payer to other insurance coverage:  Employer group health insurance for the working aged  Automobile coverage, homeowners’ policy, product liability, or property claims that provide liability coverage for personal injury or medical expenses  Disability coverage for beneficiaries under the age of 65 who are covered by a large group health plan.  Worker’s Compensation insurance for work-related injuries/illness.  The Black Lung program, responsible only for covered Black Lung services.  Services authorized for payment by the Veterans Health Administration.  Employer group health plans for the first 30 months of coverage for beneficiaries who have been diagnosed with End-Stage Renal Disease.

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Advanced Beneficiary Notices  Advanced Beneficiary Notices (ABNs) are a provider’s attestation that beneficiaries have been informed that a given service will not be covered by Medicare and will therefore be billed to them.  The notice must clearly explain why the facility feels Medicare will not pay for the service.  The notice must be provided before the procedure or service is performed and far enough in advance for the patient to make an informed choice.

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ABN Requirements At a minimum, the ABN should include:  The patient’s name  The patient’s Medicare ID number  The service(s) that will not or may not be covered  The specific reason(s) the department believes the service(s) will not be covered  A statement notifying the patient of his/her financial responsibility if Medicare denies payment While not required, the ABN does include a space for the estimated cost of services.

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Non-Covered Services Many services are not covered under the Medicare program, such as services related to self-administered drugs. Specific items/services that are considered not covered under the Medicare program include:  Routine foot care  Tests for fitting hearing aids or the hearing aids  Personal comfort items  Cosmetic surgery  Dental care and dentures  Most eyeglasses and eye exams  Custodial care

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Hospital Issued Notice of Non-coverage  The Hospital Issued Notice of Non-coverage (HINN) is another type of Advance Beneficiary Notice used by hospitals for inpatient services.  HINNs are generally used to notify a patient that a previously covered inpatient stay is no longer considered medically necessary after a specific date of service, and therefore the patient may be billed for the services after that date.

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 Standardization of patient registration pathways and processes  Streamlined flow of information with minimized variation  Using IS to facilitate collecting patient information  Ensuring that the patient is questioned only once per day, regardless of number of encounters within organization  Insurance is always verified upfront  Patients are offered payment options  Centralized Ancillary Registration  Patients given “passports” to ancillary testing sites  Waivers, ABNs, etc. are processed at registration Registration

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Health Savings Account (HSA) A Health Savings Account is a special account owned by an individual used to pay for current and future medical expenses.  HSAs are used with a “High Deductible Health Plan” (HDHP) Insurance that does not cover first dollar medical expenses (except for preventive care)  Minimum deductible of $1,100 for individuals, $2,200 family  Annual out of pocket of $5,600 for individuals, $11,200 family /

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Difficult Conversations  Patients may feel that you are being pushy or aggressive if they feel you aren’t listening to them.  Often it may be as simple as your tone of voice or facial expression. Tactics for Difficult Conversations:  Listen and ask questions  Concentrate on the bottom line  Backtrack: “Let me get this right,” “Are you saying that….?”  Clarify and focus on solutions  Know your stuff  Be positive and flexible  Respect personal space  Permit verbal venting

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 Celebrate success  Non-punitive  Weekly updates on progress  Show them the money  Need to know denials  Show them their denials  Consider lessons through working own denials Tracking and Feedback